Efficacy and safety of adjuvant chemotherapy for locally advanced cervical carcinoma: an updated Systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared adjuvant chemotherapy (ACT) after concurrent chemoradiotherapy (CCRT) with CCRT alone for locally advanced cervical cancer. It pooled 22 studies involving 7466 participants using a random-effects model. Overall, CCRT plus ACT was associated with significant improvements in overall survival, progression-free survival, and distant metastasis rate. However, subgroup analyses of randomised controlled trials, studies using more than three ACT cycles, and studies with five-year follow-up found no statistically significant overall- or progression-free-survival difference. ACT was also associated with more hematologic and gastrointestinal toxicities.

Key findings

• Across 22 studies (n = 7466), CCRT plus ACT was associated with significant improvement in overall survival and progression-free survival versus CCRT alone.
• The distant metastasis rate was significantly improved with CCRT plus ACT compared with CCRT alone.
• RCT, more-than-three-cycle, and five-year-follow-up subgroups showed no statistical difference in overall or progression-free survival between groups.
• ACT was associated with higher rates of hematologic and gastrointestinal toxicities.

Why it matters

The pooled findings suggest potential survival and distant-control benefits from adding ACT after CCRT, but the subgroup results temper confidence in a consistent survival advantage. The increased hematologic and gastrointestinal toxicity is also relevant when weighing the possible benefits and harms of this additional treatment.

What to keep in mind

The abstract does not report effect sizes or study-level quality. Subgroup analyses found no statistically significant survival difference in several groups, limiting certainty about the overall benefit.